List of ACE inhibitors: Uses, common brands, and safety information

Angiotensin-converting enzyme (ACE) inhibitors are a class of medications commonly used to treat high blood pressure, or hypertension. Managing blood pressure is essential for preventing strokes, heart disease, and kidney disease, among other health problems. 

A diagnosis of hypertension can seem daunting, especially since hypertension does not usually show any symptoms. You might not know you have hypertension until you visit with a healthcare provider. Nearly half of adults in the U.S. have high blood pressure, but, fortunately, there are several medications available to manage it. The ACE inhibitor class of drugs is one treatment option.

Continue reading to learn more about ACE inhibitors, their uses, and their side effects. 

What are ACE inhibitors?

ACE inhibitors are a class of medications that lower blood pressure by relaxing veins and arteries. These medications stop the production of a hormone called angiotensin II. This hormone is responsible for narrowing your blood vessels, which can raise blood pressure. By relaxing blood vessels and decreasing blood pressure, ACE inhibitors can help increase blood flow and reduce the workload on the heart. These medications are often prescribed to those who have hypertension, heart failure, kidney problems, diabetes, and other conditions involved with the blood vessels and blood flow. 

How do ACE inhibitors work?

ACE inhibitors block the angiotensin-converting enzyme, which converts angiotensin I to angiotensin II. Angiotensin II is a potent hormone that causes the smooth muscles around the blood vessels to contract, resulting in the narrowing of blood vessels and a rise in blood pressure. 

When ACE inhibitors block angiotensin II production, blood vessels can expand to allow blood to flow more freely. Treatment with ACE inhibitors can promote decreased blood pressure, reduced damage to blood vessel walls, and improved blood flow to the heart and kidneys. Lowering blood pressure can also improve heart function in heart failure and slow the progression of kidney disease caused by diabetes or hypertension. 

What are ACE inhibitors used for?

ACE inhibitors are primarily used to treat high blood pressure but may also used be used to treat the following conditions:

• Coronary artery disease

• Heart failure

• Diabetes

• Chronic kidney disease

• Scleroderma

• Migraines

In those who have heart failure, heart attacks, diabetes, or chronic kidney disease, ACE inhibitors are considered a first-line therapy for lowering blood pressure or reducing the risk of complications. ACE inhibitors also have a cardioprotective effect independent of their ability to lower blood pressure. In other words, these drugs can help protect the heart from damage caused by hypertension and heart disease. 

ACE inhibitors may be combined with other medications such as diuretics or calcium channel blockers.

Who can take ACE inhibitors?

Adults

ACE inhibitors are commonly used to treat hypertension in adults. An ACE inhibitor is a first-line therapy for adults that are less than 60 years of age and non-African American. ACE inhibitors tend to be less effective in the African American population. Adults with diabetes may also be prescribed an ACE inhibitor to reduce the risk of diabetic nephropathy, or kidney disease that develops in those with diabetes. 

Children

ACE inhibitors can be used to treat hypertension in children. They are also a preferred medication in children who have chronic kidney disease or diabetes. Children of African ancestry may need a higher starting dose. Several ACE inhibitors, like Lotensin and Prinivil, are safe for children aged 6 years of age and older; however, a few formulas are also safe for younger children. For example, Capoten may be given to infants, and Vasotec may be given to children aged one month and older. 

Seniors

Older adults can safely take ACE inhibitors but may require a smaller dose than younger adults. Starting doses may be lower and gradually titrated upward to achieve the desired effect. 

Are ACE inhibitors safe?

In general, ACE inhibitors are considered safe with few serious side effects when taken as prescribed. However, there are a few groups of people that should not take ACE inhibitors.

People with severe kidney failure should not take ACE inhibitors. Kidney function would need to be closely monitored if an ACE inhibitor were used in this population. People who have had an allergic reaction after taking an ACE inhibitor that resulted in a severe rash, trouble breathing, or swelling of the lips, tongue, or mouth, should also avoid taking an ACE inhibitor. 

Certain drugs may decrease the effectiveness of ACE inhibitors. For example, over-the-counter (OTC) nonsteroidal anti-inflammatory drugs (NSAIDs) can decrease the effectiveness of ACE inhibitors. Combining NSAIDs with ACE inhibitors should be avoided or monitored. Talk to a healthcare provider about any medications you may take, such as OTC drugs, supplements, and herbs, before taking an ACE inhibitor. 

ACE inhibitor recalls

There are no current ACE inhibitor recalls as of March 2021.

ACE inhibitor restrictions

Do not take ACE inhibitors if you have had an allergic reaction to any ACE inhibitor. If you have ever experienced angioedema (swelling under the skin similar to hives), do not take ACE inhibitors. 

Patients taking Entresto (sacubitril/valsartan), a drug that contains a neprilysin inhibitor, should not take an ACE inhibitor. Entresto should not be taken within 36 hours of switching to or from an ACE inhibitor. 

Individuals with severe aortic stenosis who are taking ACE inhibitors may experience reduced coronary perfusion resulting in ischemia, or decreased blood flow to the heart muscle. 

Can you take ACE inhibitors while pregnant or breastfeeding?

The ACE inhibitor class carries a black box warning against use during pregnancy. ACE inhibitors can cause injury and death to a developing fetus. Additionally, ACE inhibitors may cross into breast milk and should be avoided while breastfeeding. Consult a healthcare provider for treatment options for high blood pressure before taking an ACE inhibitor while pregnant or breastfeeding.

Are ACE inhibitors controlled substances?

No, ACE inhibitors are not controlled substances. 

Common ACE inhibitors side effects

The most common side effects of ACE inhibitors include:

• Dry cough

• Dizziness

• Elevated blood potassium levels

• Low blood pressure

• Headache

• Fatigue

• Weakness

• Rash

• Loss of taste

Low blood pressure or episodes of passing out can occur with the first several doses of ACE inhibitors. This tends to occur more in individuals who are volume-depleted when starting an ACE inhibitor. Fluid imbalances may need to be corrected before starting an ACE inhibitor.

More severe but rare side effects of ACE inhibitors include:

• Kidney problems

• Allergic reactions

• Pancreatitis

• Liver dysfunction

• Decreased white blood cells

• Angioedema

Although rare, ACE inhibitors can have serious side effects. One adverse event is angioedema, or swelling underneath the skin of the face or other body parts. An allergic reaction to ACE inhibitors is also rare but possible. ACE inhibitors may cause kidney failure, so your healthcare provider should regularly test your kidney function during treatment. 

ACE inhibitors can raise blood potassium levels and cause hyperkalemia (higher potassium levels than normal), so monitoring potassium intake while taking an ACE inhibitor is often necessary. Taking potassium supplements or using salt substitutes containing potassium while on an ACE inhibitor may cause hyperkalemia, which can lead to other health problems and potentially be life-threatening. Signs of having too much potassium in the body include confusion, irregular heartbeat, and tingling or numbness in the hands or face.

This list of side effects is not comprehensive. Speaking with a healthcare professional is the best way to get a complete list of side effects and determine whether taking ACE inhibitors is suitable.

Tell your doctor about any of the following before taking an ACE inhibitor:

• Any drug allergies

• If you’ve ever experienced angioedema

• If you have kidney problems

• If you have taken a drug that has sacubitril in it in the last 36 hours

• If you are pregnant or breastfeeding

How much do ACE inhibitors cost?

ACE inhibitors are generally affordable medications that are available in brand-name and generic formulas. Almost all Medicare and insurance plans will cover ACE inhibitors. Costs will vary depending on your insurance plan. Without insurance, the price can vary widely depending on the medication and quantity of tablets prescribed. However, using a prescription discount card from SingleCare may help reduce the cost of ACE inhibitors.